PATRICE R FREDERICK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047548

License Status

EXPIRED

Business

First Name

PATRICE

Middle

Last Name

FREDERICK

Business Name

PATRICE R FREDERICK

Original Issue Date

06/28/2004

Effective Date

06/28/2004

Expiration Date

06/27/2007

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

07/03/2007